'As required' medication regimens for seriously mentally ill people in hospital

Chakrabarti, Abhijit; Whicher, Emma; Morrison, Murray; Douglas-Hall, Petrina

doi:10.1002/14651858.cd003441.pub2

Cited by 27 publications

(23 citation statements)

References 24 publications

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“…In the present study, PRN- medication was not significantly associated with on the following day’s DASA total score, implying that it did not decrease the perceived risk of violence. It has been stated that the current use of PRN- medication is based on clinical experience and habit rather than high quality evidence of real pharmacological effect [28]. The use of PRN-medication often lacks a clear chain of accountability and nurses are reluctant to increase their responsibilities for assessing the need for extra medication [29].…”

Section: Discussionmentioning

confidence: 99%

Interventions following a high violence risk assessment score: a naturalistic study on a Finnish psychiatric admission ward

Kaunomäki

Jokela

Kontio

et al. 2017

BMC Health Serv Res

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BackgroundPatient aggression and violence against staff members and other patients are common concerns in psychiatric units. Many structured clinical risk assessment tools have recently been developed. Despite their superiority to unaided clinical judgments, staff has shown ambivalent views towards them. A constant worry of staff is that the results of risk assessments would not be used. The aims of the present study were to investigate what were the interventions applied by the staff of a psychiatric admission ward after a high risk patient had been identified, how frequently these interventions were used and how effective they were.MethodsThe data were collected in a naturalistic setting during a 6-month period in a Finnish psychiatric admission ward with a total of 331 patients with a mean age of 42.9 years (SD 17.39) suffering mostly from mood, schizophrenia-related and substance use disorders. The total number of treatment days was 2399. The staff assessed the patients daily with the Dynamic Appraisal of Situational Aggression (DASA), which is a structured violence risk assessment considering the upcoming 24 h. The interventions in order to reduce the risk of violence following a high DASA total score (≥4) were collected from the patients’ medical files. Inductive content analysis was used.ResultsThere were a total of 64 patients with 217 observations of high DASA total score. In 91.2% of cases, at least one intervention aiming to reduce the violence risk was used. Pro re nata (PRN)-medication, seclusion and focused discussions with a nurse were the most frequently used interventions. Non-coercive and non-pharmacological interventions like daily activities associated significantly with the decrease of perceived risk of violence.ConclusionIn most cases, a high score in violence risk assessment led to interventions aiming to reduce the risk. Unfortunately, the most frequently used methods were psychopharmacological or coercive. It is hoped that the findings will encourage the staff to use their imagination when choosing violence risk reducing intervention techniques.

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Section: Discussionmentioning

confidence: 99%

Interventions following a high violence risk assessment score: a naturalistic study on a Finnish psychiatric admission ward

Kaunomäki

Jokela

Kontio

et al. 2017

BMC Health Serv Res

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“…Another problem is that there is a lack of scientific evidence for the effectiveness of PRN medication. There have been two systematic reviews of the subject and both of these failed to find good-quality evidence of the efficacy of PRN medication (Chakrabarti, Whicher, Morrison, & Douglas-Hall, 2007;Srivastava, 2009). Neither review identified any randomised controlled trials of PRN medication and Chakrabarti et al (2007) concluded that the current practice of making common use of PRN 'is based on clinical experience and habit rather than high quality evidence'.…”

Section: Introductionmentioning

confidence: 99%

“…There have been two systematic reviews of the subject and both of these failed to find good-quality evidence of the efficacy of PRN medication (Chakrabarti, Whicher, Morrison, & Douglas-Hall, 2007;Srivastava, 2009). Neither review identified any randomised controlled trials of PRN medication and Chakrabarti et al (2007) concluded that the current practice of making common use of PRN 'is based on clinical experience and habit rather than high quality evidence'. In an interesting retrospective study of new admissions conducted in a US state hospital, PRN psychotropic medication orders were not permitted for a three-month experimental period (Thapa et al, 2003).…”

Section: Introductionmentioning

confidence: 99%

A study of the use of sedative PRN medication in patients at a secure hospital

Haw

Wolstencroft

2014

The Journal of Forensic Psychiatry & Psychology

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We have investigated the use of 'as required' (PRN), sedative psychotropic medication in 242 forensic rehabilitation patients at a UK secure psychiatric hospital. In total, 176 (73%) patients were prescribed PRN medication and 90 (37%) received a total of 542 doses in the preceding two weeks. The principle indication for use was agitation. Oral benzodiazepines, particularly Lorazepam, were most commonly prescribed and administered followed by Haloperidol. Although high-dose antipsychotics and polypharmacy due to PRN prescribing were common (11 and 20%, respectively), on only 6% of the days studied did patients actually receive PRN antipsychotic medication. Using univariate analyses, PRN administration was associated with younger age, female gender, emotionally unstable personality disorder, shorter length of stay and detention in medium security. Case note documentation of PRN administration was often absent (44%) or vague. Further research, both quantitative and qualitative, is needed into the precise circumstances under which PRN is administered.

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“…There is limited evidence of the effectiveness of prn medication in adult psychiatric inpatients. Chakrabarti et al published a Cochrane systematic review of prn psychotropic medications in acute mental health settings [12]. They concluded that there is no evidence about the risks and benefits of prn medication regimens as compared to regular regimens.…”

Section: Discussionmentioning

confidence: 99%

The use ofprnmedication in a child and adolescent mental health inpatient service in France

Winterfeld

Heuzey

Acquaviva

et al. 2009

International Journal of Psychiatry in Clinical Practice

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Objective. The aim of this study was to investigate the use of "as needed" (pro re nata or prn) psychotropic medication in a child and adolescent psychiatric inpatient population. The study was carried out on the psychiatry ward of a paediatric teaching hospital in Paris, France. Methods. A prospective analysis of prn psychotropic drug prescriptions and administrations was conducted for all patients hospitalised over a period of 4 months. The study group consisted of 187 patients. Results. In total, 93 prn prescriptions were written, for 27% of the patients (51) but only 14% (26) received a total of 76 administrations. Antipsychotic drugs accounted for 54% of the prescriptions, anxiolytics for 33%, antiepileptic drugs for 8%, antiparkinsonian drugs for 4% and hypnotic drugs for 1%. Anxiety was the reason given for 67% of the prn administrations, with hydroxyzine used in 69% of these cases. Disruptive behaviour accounted for 22% of prn administrations, with antipsychotic drugs accounting for 88% of these administrations. Insomnia accounted for 8% of prn administrations, and antipsychotic drug-induced dystonia accounted for 3% of such administrations. Conclusion. Controlled studies are required to assess the efficacy and safety of prn medication and the conditions in which its use is indicated.

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'As required' medication regimens for seriously mentally ill people in hospital

Cited by 27 publications

References 24 publications

Interventions following a high violence risk assessment score: a naturalistic study on a Finnish psychiatric admission ward

Interventions following a high violence risk assessment score: a naturalistic study on a Finnish psychiatric admission ward

A study of the use of sedative PRN medication in patients at a secure hospital

The use ofprnmedication in a child and adolescent mental health inpatient service in France

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